Healthcare Provider Details

I. General information

NPI: 1023039435
Provider Name (Legal Business Name): ROBERT RANDALL SCHAFFER M.D., FAAFP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: R RANDALL SCHAFFER M.D., FAAFP

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 513-423-3309
Mailing address:
  • Phone: 614-257-5800
  • Fax: 614-257-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME91795
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6192
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35056157
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: